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Fundamento y objetivos El principal objetivo terapeutico en la fibrilacion auricular (FA) es la prevencion del ictus. Estudiamos la adecuacion del tratamiento antitrombotico y la estrategia terapeutica adoptada respecto a las Guias Clinicas, asi como las caracteristicas de los pacientes atendidos en atencion primaria. Pacientes y metodos Estudio transversal, multicentrico, en pacientes atendidos en centros de salud de toda Espana. Muestreo bietapico por comunidades y centros de salud. Participaron 185 medicos de familia, cuyos pacientes fueron seleccionados aleatoriamente. Resultados De 3.759 pacientes con FA aleatorizados centralizadamente, se evaluaron 2.070 (entrevista e historia clinica) con una edad media de 74 (11) anos (50,7% mujeres), presentando la mayoria (78%) FA permanente asociada a frecuente comorbilidad (hipertension 75%, obesidad 30%, diabetes 27%, insuficiencia cardiaca 20%, cardiopatia isquemica 17% y riesgo social 15%). En atencion primaria se diagnosticaron mas pacientes asintomaticos (36%; p < 0,001) que en el ambito hospitalario. Se adopto una estrategia de control de frecuencia en 4 de cada 5 pacientes. Se observo una amplia utilizacion de la anticoagulacion oral (84%), mayor en pacientes con FA permanente frente a no permanente (91 frente al 60%; p < 0,001). El seguimiento era principalmente realizado en atencion primaria (72%), presentando un 66% de los pacientes su ultimo international normalized ratio (INR, «razon normalizada internacional») en rango terapeutico, que descendia al 33% al considerar los 3 ultimos INR (p < 0,001). Conclusiones La proporcion de pacientes con FA que reciben anticoagulacion en atencion primaria es elevada, sin embargo, el control del INR resulta suboptimo. La estrategia adoptada es el control de frecuencia en la mayoria de los casos. La estratificacion del riesgo embolico deberia sustituir al tipo de arritmia en la decision terapeutica. more...

The main therapeutic objective in atrial fibrillation (AF) patients is stroke prevention. This study is aimed to determine whether the anticoagulant therapy may be appropriate regarding to the Guidelines and patients' profile in primary healthcare in Spain.A national, multicenter, cross-sectional study of AF patients attended in primary healthcare in Spain has been conducted. The study involved 185 family physicians whose patients were randomized.A total of 3,759 AF patients were randomized from the clinical records, and 2,070 were included in the study, at an average age of 74 (11) years old (50.7% female). Most of them (78%) had permanent AF and high comorbidity rates (hypertension 75%, obesity 30%, diabetes 27%, heart failure 20%, coronary heart disease 17%, and social risk 15%). Patients diagnosed in primary healthcare were more frequently asymptomatic than in hospital setting (36%; P.001). The therapeutic strategy was based on the heart rate control in 4 out of 5 patients. Anticoagulation therapy was widely used (84%), more frequently in patients with permanent vs. non-permanent AF (91 vs. 60%, P.001). Follow-up and monitoring was mainly performed in primary care (72%). The anticoagulation control was suboptimal, with a 66% of the international normalized ratio (INR) in therapeutic range, dropping to 33% when the last 3 available INR were included (P.001).A high rate of patients with anticoagulant therapy in primary healthcare has been found in this research. INR control, however, remains suboptimal. Heart rate control is the most commonly used strategy. The decision about the anticoagulation should be based on the thromboembolic risk rather than in the arrhytmia type. more...